scholarly journals Is this really trigeminal neuralgia? Diagnostic re-evaluation of patients referred for neurosurgery

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Haldor Slettebø
Keyword(s):  
Retrospective Study ◽  
Trigeminal Neuralgia ◽  
Physical Examination ◽  
Facial Pain ◽  
Low Grade ◽  
Clinical Criteria ◽  
Neurosurgical Treatment ◽  
Mri Scans ◽  
First Time ◽  
Dental Conditions

Abstract Objectives Patients with facial pain are sometimes referred for neurosurgical treatment with a poorly documented diagnosis of trigeminal neuralgia. In such cases, neurosurgery will usually not be helpful. We conducted a re-evaluation of the diagnosis in patients referred for neurosurgical treatment of presumed trigeminal neuralgia. Our objective was to find out why and how often misdiagnosis occurred. Methods A retrospective study was done in consecutive first-time patients referred for trigeminal neuralgia to our outpatient clinic in 2019. We used five ICHD-3-based clinical criteria to verify or exclude the diagnosis. In patients where trigeminal neuralgia was excluded, we established a diagnosis for their facial pain based upon medical history and a physical examination by a neurosurgeon – often supplemented with examination by an oral surgeon. Results Thirty-eight patients were referred for presumed trigeminal neuralgia. Only 17 of them fulfilled the five criteria and were diagnosed with trigeminal neuralgia. In 20 of the remaining 21 patients trigeminal neuralgia could be clearly excluded, while one of the patients had a periodontitis closely mimicking trigeminal neuralgia. In 14 of the 21 patients we diagnosed temporomandibular dysfunction or dental conditions. MRI scans had detected low-grade neurovascular contacts in 13 of the 21 patients, a finding that was clearly overestimated by the referring neurologists in seven patients. Conclusions Overdiagnosis of trigeminal neuralgia was common in patients referred for neurosurgery, mostly due to insufficient clinical evaluation combined with an overestimation of MRI-detected NVCs. The clinical diagnosis should be critically re-evaluated before recommending neurosurgery to patients referred for presumed trigeminal neuralgia.

Dermoscopy of Dermatofibrosarcoma Protuberans

2021 ◽  
Author(s):  
Nissrine Amraoui
Keyword(s):  
Patient Outcome ◽  
Soft Tissue ◽  
Physical Examination ◽  
Delayed Diagnosis ◽  
Dermatofibrosarcoma Protuberans ◽  
Low Grade ◽  
Malignant Tumours ◽  
Soft Tissue Neoplasm ◽  
Clinical Criteria ◽  
Grade Malignancy

ermatofibrosarcoma protuberans (DFSP), also known as dermatofibrosarcoma of Darier and Ferrand, is a soft-tissue neoplasm of intermediate to low-grade malignancy, which accounts for 0.1–1% of all cutaneous malignant tumours [1]. The diagnosis of this entity is based on physical examination and a confirmative biopsy sample [2-5]. However, the lack of reliable clinical criteria suggestive of DFSP results in delayed diagnosis and poorer patient outcome.

scholarly journals Prevalence of orofacial Pain among working adults - A Retrospective Study

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 496-502
Author(s):  
Kalyani P ◽  
Manjari Chaudhary ◽  
Santhosh Kumar M. P.
Keyword(s):  
Retrospective Study ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Orofacial Pain ◽  
Time Frame ◽  
P Value ◽  
Atypical Facial Pain ◽  
Chi Square ◽  
Female Ratio ◽  
Working Adults

Orofacial pain can be defined as a discipline of dentistry that deals with the diagnosis and management of different types of pain pertaining to the orofacial region such as the trigeminal neuralgia, atypical facial pain, postherpetic neuralgia, etc. The aim of the current study is to determine the prevalence of Orofacial Pain among working adults. The retrospective study involved the analysis of the case sheets of the patients with orofacial pain in the stipulated time frame and assessment based on the following parameters: age, gender, the type of orofacial pain, working status—statistical analysis calculated by chi-square test. A p-value <0.05 was considered significant. The prevalence of orofacial pain was 0.08% with a female - to - the male ratio of 1.06: 1 and working adults to non-working adults ratio of 1.36: 1. Trigeminal neuralgia shows a male-female ratio of 1.18: 1 and higher prevalence of Atypical facial pain in females (15.15%). According to our study, it can be concluded that orofacial pain was more prevalent in females. The prevalence of Trigeminal Neuralgia was higher in males and Atypical facial pain was the most prevalent type in females.

Role of patient history and physical examination in the diagnosis of trigeminal neuralgia

2005 ◽  
Vol 18 (5) ◽  
pp. 1-4 ◽  
Author(s):  
Kenneth F. Casey
Keyword(s):  
Primary Care ◽  
Trigeminal Neuralgia ◽  
Physical Examination ◽  
Facial Pain ◽  
Patient History ◽  
Simple Scheme ◽  
Care Givers ◽  
Patient’S History

The diagnosis of facial pain has been a source of confusion for neuroscientists and primary care givers alike. The profusion of various subtypes, differential syndromes, and confusing nomenclature is silent testimony to this dilemma. The author presents a simple scheme with which to arrive at the diagnosis. The use of the patient's history, confirmed by the physical examination, can be supplemented with some of the tests described herein.

scholarly journals Neuronavigated percutaneous approach to the sphenopalatine ganglion

2017 ◽  
Vol 126 (2) ◽  
pp. 375-378 ◽  
Author(s):  
Nicola Benedetto ◽  
Paolo Perrini
Keyword(s):  
Trigeminal Neuralgia ◽  
Cluster Headache ◽  
Gold Standard ◽  
Facial Pain ◽  
Technical Note ◽  
Sphenopalatine Ganglion ◽  
Atypical Facial Pain ◽  
Percutaneous Approach ◽  
Percutaneous Procedures ◽  
First Time

The sphenopalatine ganglion (SPG) has been assumed to be involved in the genesis of several types of facial pain, including Sluder's neuralgia, trigeminal neuralgia, persistent idiopathic facial pain, cluster headache, and atypical facial pain. The gold standard treatments for SPG-related pain are percutaneous procedures performed with the aid of fluoroscopy or CT. In this technical note the authors present, for the first time, an SPG approach using the aid of a neuronavigator.

ENDOSCOPIC RESECTION OF LOW GRADE DYSPLASIA IN BARRETT’S OESOPHAGUS: A RETROSPECTIVE STUDY ABOUT 61 PATIENTS

2020 ◽  
Author(s):  
Fabrice Caillol ◽  
Arthur Falque ◽  
Margherita Pizzicannella ◽  
Christian Pesenti ◽  
Jean Philippe Ratone ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Endoscopic Resection ◽  
Barrett’S Oesophagus ◽  
Low Grade ◽  
Barrett's Oesophagus ◽  
Low Grade Dysplasia

Seizures following surgery for supratentorial extratemporal low-grade tumors in children: a multicenter retrospective study

2020 ◽  
Vol 26 (1) ◽  
pp. 27-33
Author(s):  
Jonathan Roth ◽  
Or Bercovich ◽  
Ashton Roach ◽  
Francesco T. Mangano ◽  
Arvind C. Mohan ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Brain Tumors ◽  
Seizure Control ◽  
Seizure Activity ◽  
Refractory Epilepsy ◽  
Low Grade ◽  
Refractory Seizures ◽  
Low Rate ◽  
Over Time ◽  
New Onset

OBJECTIVEResection of brain tumors may lead to new-onset seizures but may also reduce seizure rates in patients presenting with seizures. Seizures are seen at presentation in about 24% of patients with brain tumors. For lesional epilepsy in general, early resection is associated with improved seizure control. However, the literature is limited regarding the occurrence of new-onset postoperative seizures, or rates of seizure control in those presenting with seizures, following resections of extratemporal low-grade gliomas (LGGs) in children.METHODSData were collected retrospectively from 4 large tertiary centers for children (< 18 years of age) who underwent resection of a supratentorial extratemporal (STET) LGG. The patients were divided into 4 groups based on preoperative seizure history: no seizures, up to 2 seizures, more than 2 seizures, and uncontrolled or refractory epilepsy. The authors analyzed the postoperative occurrence of seizures and the need for antiepileptic drugs (AEDs) over time for the various subgroups.RESULTSThe study included 98 children. Thirty patients had no preoperative seizures, 18 had up to 2, 16 had more than 2, and 34 had refractory or uncontrolled epilepsy. The risk for future seizures was higher if the patient had seizures within 1 month of surgery. The risk for new-onset seizures among patients with no seizures prior to surgery was low. The rate of seizures decreased over time for children with uncontrolled or refractory seizures. The need for AEDs was higher in the more active preoperative seizure groups; however, it decreased with time.CONCLUSIONSThe resection of STET LGGs in children is associated with a low rate of postoperative new-onset epilepsy. For children with preoperative seizures, even with uncontrolled epilepsy, most have a significant improvement in the seizure activity, and many may be weaned off their AEDs.

scholarly journals Percutaneous radiofrequency treatment of the gasserian ganglion for trigeminal neuralgia complicated by trochlear nerve palsy: a case report

2021 ◽  
pp. rapm-2020-102285
Author(s):  
Pascal SH Smulders ◽  
Michel AMB Terheggen ◽  
José W Geurts ◽  
Jan Willem Kallewaard
Keyword(s):  
Trigeminal Neuralgia ◽  
Cranial Nerve ◽  
Facial Pain ◽  
Anatomical Variations ◽  
Anterior Inferior Cerebellar Artery ◽  
Gasserian Ganglion ◽  
Radiofrequency Treatment ◽  
Experienced Pain ◽  
Cerebellar Artery ◽  
Trochlear Nerve Palsy

BackgroundTrigeminal neuralgia (TN) has the highest incidence of disorders causing facial pain. TN is provoked by benign stimuli, like shaving, leading to severe, short-lasting pain. Patients are initially treated using antiepileptic drugs; however, multiple invasive options are available when conservative treatment proves insufficient. Percutaneous radiofrequency treatment of the trigeminal, or gasserian, ganglion (RF-G) is a procedure regularly used in refractory patients with comorbidities. RF-G involves complex needle maneuvering to perform selective radiofrequency heat treatment of the affected divisions. We present a unique case of cranial nerve 4 (CN4) paralysis after RF-G.Case presentationA male patient in his 60s presented with sharp left-sided facial pain and was diagnosed with TN, attributed to the maxillary and mandibular divisions. MRI showed a vascular loop of the anterior inferior cerebellar artery without interference of the trigeminal complex. The patient opted for RF-G after inadequate conservative therapy. The procedure was performed by an experienced pain physician and guided by live fluoroscopy. The patient was discharged without problems but examined the following day for double vision. Postprocedural MRI showed enhanced signaling between the trigeminal complex and the brainstem. Palsy of CN4 was identified by a neurologist, and spontaneous recovery followed 5 months after the procedure.ConclusionsMention of postprocedural diplopia in guidelines is brief, and the exact incidence remains unknown. Different mechanisms for cranial nerve (CN) palsy have been postulated: incorrect technique, anatomical variations, and secondary heat injury. We observed postprocedural hemorrhage and hypothesized that bleeding might be a contributing factor in injury of CNs after RF-G.

scholarly journals The Dose of Somatostatin Analogues during Pre-Surgical Treatment Is a Key Factor to Achieve Surgical Remission in Acromegaly

Endocrines ◽  
2021 ◽  
Vol 2 (3) ◽  
pp. 241-250
Author(s):  
Marta Araujo-Castro ◽  
Eider Pascual-Corrales ◽  
Héctor Pian ◽  
Ignacio Ruz-Caracuel ◽  
Alberto Acitores Cancela ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Surgical Outcomes ◽  
Pituitary Adenomas ◽  
Somatostatin Analogues ◽  
Beneficial Effects ◽  
Key Factor ◽  
Long Acting ◽  
First Time ◽  
Endocrine Complications

Purpose: to determine whether pre-surgical treatment using long-acting somatostatin analogues (SSAs) may improve surgical outcomes in acromegaly. Methods: retrospective study of 48 patients with acromegaly operated by endoscopic transsphenoidal approach and for first time. Surgical remission was evaluated based on the 2010 criteria. Results: most patients, 83.3% (n = 40), harbored macroadenomas and 31.3% (n = 15) invasive pituitary adenomas. In this case, 14 patients were treated with lanreotide LAR and 6 with octreotide LAR, median monthly doses of 97.5 [range 60–120] and 20 [range 20–30] mg, respectively, for at least 3 months preoperatively. Presurgical variables were comparable between pre-treated and untreated patients (p > 0.05). Surgical remission was more frequent in those pre-treated with monthly doses ≥90 mg of lanreotide or ≥30 mg of octreotide than in untreated or pre-treated with lower doses (OR = 4.64, p = 0.025). However, no differences were found between pre-treated and untreated patients when lower doses were included or between those treated for longer than 6 months compared to those untreated or pre-treated for shorter than 6 months. Similarly, no differences were found either in terms of surgical or endocrine complications (OR = 0.65, p = 0.570), independently of the doses and the duration of SSA treatment (p > 0.05). Conclusions: the dose of SSAs is a key factor during pre-surgical treatment, since the beneficial effects in surgical remission were observed with monthly doses equal or higher than 90 mg of lanreotide and 30 mg of octreotide, but not with lower doses.

scholarly journals A novel method to treat recurrent facial pain: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Jintakorn Kuvatanasuchati ◽  
Karoon Leowsrisook
Keyword(s):  
Case Report ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Case Presentation ◽  
Facial Movements ◽  
Novel Treatment ◽  
Effective Cost ◽  
Novel Method

Abstract Background Chronic facial pain is a serious condition affecting millions of people worldwide. The reasons for chronic facial pain vary, and currently, the methods of treating chronic facial pain are expensive, invasive, and, based on current findings, ineffective. The purpose of this study is to develop and test an effective, cost-friendly method to treat patients with chronic facial pain. This study will examine the effectiveness of a novel treatment of a patient suffering from trigeminal neuralgia. Case presentation A 70-year-old Thai female visited the advanced general dentistry clinic at the Faculty of Dentistry, Mahidol University, Bangkok, Thailand. She was suffering from facial pain on her left side and was diagnosed by a physician as having trigeminal neuralgia. She experienced a sharp shooting pain that was triggered by facial movements such as chewing, speaking, or brushing teeth, and touching certain areas of her face. Bouts of pain lasted from a few seconds to several minutes, and episodes of several attacks lasted days, weeks, months, or longer prior to her visit to the advanced general dentistry clinic at Mahidol University. Physician designed an occlusal equilibration appliance for treating the patient by inserting the appliance in the mouth for dental occlusal equilibration (deprogram). The patient used this appliance by placing it in the mouth continuously (day and night) and removed it only when eating. After using the appliance for 2 weeks, the patient appeared to feel and look better prior to taking medication and was able to eat normally. The patient was pain free after treatment for a duration of 9 months. However, after 9 months, the pain reoccurred and manifested itself. Conclusion This novel treatment of recurrent facial pain showed an improvement of the patient’s chronic facial pain and serves as evidence to being a novel method for treating those suffering from trigeminal neuralgia.

scholarly journals LINC-42. EPIDEMIOLOGICAL OVERVIEW OF CHILDHOOD CNS TUMORS IN THE NEUROSURGICAL UNIT IN YEREVAN, ARMENIA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii386-iii386
Author(s):  
Nune Karapetyan ◽  
Samvel Danielyan ◽  
Gevorg Tamamyan ◽  
Armen Tananyan ◽  
Liana Safaryan ◽  
...  
Keyword(s):  
Medical Center ◽  
Survival Rates ◽  
Developed Countries ◽  
Cns Tumors ◽  
Malignant Neoplasms ◽  
Low Grade ◽  
Embryonal Tumors ◽  
Low Grade Gliomas ◽  
Neurosurgical Treatment

Abstract BACKGROUND Central nervous system (CNS) tumors are the second most common malignant neoplasms among children worldwide. The current paper aims to analyze the situation in pediatric neuro-oncology in Armenia from the neurosurgical perspective. METHODS We have collected data of pediatric patients with CNS tumors treated in the Neurosurgery department of “Surb Astvasamayr” Medical Center from 01.01.2010 till 01.12.2019. Incidence by gender, age at diagnosis, and histopathology results were calculated. Survival rates were calculated based on the follow-up results performed until 30.12.2019. RESULTS Hospital-based data showed that during the previous 10 years 47 patients with CNS tumors received neurosurgical treatment in the unit, among them 66% were females. 38.3%, 31.9% and 29.8% of diagnosed patients were aged 0–4, 5–9, and 10–18 respectively. In 41 cases, the disease was not disseminated at diagnosis. The most common observed malignancies were low-grade gliomas (21.3%) and embryonal tumors (19.1%), followed by high-grade gliomas (14.9%) and ependymal tumors (8.5%). Follow-up information only for 33 patients is available. From them, 14 are dead and 19 alive. Survival rates in most common groups were 62.5%, 80%, 50%, and 50% respectively. The median follow-up time was 18 months (range 1–113 months). CONCLUSION Similar to the data reported in the literature, low-grade gliomas, and embryonal tumors are the most frequent pediatric CNS tumors in Armenia. On the other hand, the pediatric CNS tumor survival rates are lower compared to those reported in developed countries.

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